2020 has been a challenging year. The seniors housing and care sector was thrust into an adrenaline-fueled, 24/7 pitched battle to protect millions of America’s most vulnerable citizens from the deadly COVID-19 global pandemic. Leaders across the sector have been challenged by regulatory inconsistencies, sweeping changes in public policy, an intense media spotlight, evolving consumer attitudes, changes in healthcare delivery, the implementation of new technology, mental and physical health concerns of staff and residents, and uncertainty in capital markets – just to name a few.

NIC has responded to these challenges by doing what we do best: provide data, analysis, and a platform for connections. Since mid-March, we have launched a number of initiatives designed to improve our understanding of the impact of the pandemic on the seniors housing and care industry. Much of this information can be found on the COVID-19 Resource Center on NIC.org.

As the situation evolves, it is essential that industry leaders be able to share lessons learned, discuss strategies, hear the latest insights and continue to connect with one another, even as travel restrictions and risk of infection continues to make in-person gatherings and networking nearly impossible. NIC is therefore temporarily shifting from its traditional emphasis on a major in-person spring conference event.

For the first half of 2021, NIC is pivoting to provide a program of online opportunities for seniors housing and care leaders both to stay informed and connected across the industry.

To that end, NIC is extending the extremely popular “Leadership Huddle” webinar series and enhancing it with the addition of post-webinar ‘peer-to-peer’ breakout sessions designed to facilitate further discussion, moderated by webinar hosts and experts. Made possible by our generous partners and sponsors, the entire series of Leadership Huddle webinars will be complimentary and open to attendees across the industry.

The series of enhanced Leadership Huddle webinars will kick off on Wednesday, January 27, and then will continue, with additional events to be held on the 2nd and 4th weeks of each month, through the first half of 2021. Attendees of NIC conferences can expect the same high level of expertise, analysis, insight, and thought-leadership typically found in our conference programming. The program will enable NIC to be able to provide the most relevant, timely, and impactful subject-matter, keeping pace with change as it occurs.

2021 will likely bring further change, hopefully bringing America, and the seniors housing and care industry, beyond this crisis and into a new normal, in which in-person events are again possible. Until then, NIC will continue to take a nimble, adaptive approach, in order to continue to offer industry leaders and stakeholders the most efficient, effective means to stay informed, share information, and connect with one another.

Partners and sponsors, who typically enjoy opportunities for recognition and visibility at the NIC Spring Conference, can, instead, now choose to gain visibility and associate their brands with NIC’s via Leadership Huddle webinar presentations, as well as a variety of other opportunities, some of which are unique this coming year. Interested parties can sign up to receive up-to-date information on all upcoming sponsorship opportunities here.

In the absence of large, in-person events, NIC’s pivot to develop the industry’s premier digital properties, with the support of partners and sponsors, is a major opportunity to gain visibility and recognition with industry leaders, where they will safely and efficiently convene online, throughout the entire year.

NIC MAP^® Data Service released its latest Skilled Nursing Monthly Report on December 2, 2020, which includes key monthly data points from January 2012 through September 2020.   

Here are some key takeaways from the report: 

1. Occupancy challenges continue for skilled nursing properties as the occupancy rate stood at 74.0% in September 2020, the most updated figure from this survey. While up 12 basis points from 73.9% in August, the September level was 10.9 percentage points below the recent February peak of 84.9%. Since February, the COVID-19 pandemic has significantly impacted skilled nursing operations across the country. Occupancy is down 10.2 percentage points from the September 2019 level of 84.2%. 
   
2. The decline has been more severe in urban areas as occupancy fell 11.8 percentage points since February versus the 8.0 percentage point decline in rural areas in that same period. As the country and the skilled nursing sector navigate through the coming fall/winter months, COVID-19 cases are likely to continue to grow and could further pressure occupancy lower. The funds from the CARES Act and other implemented policies, such as the 3-Day waiver, have helped to support skilled nursing properties thus far and into the first nine months of the pandemic, but additional stimulus is most likely needed for many operators to make it through to the other side of the pandemic.  
   
3. Managed Medicare patient day mix increased 33 basis points to 6.3% in September 2020 after hitting a 7-year low during the pandemic of 5.4% in May.  However, it is down 29 basis points since March and has decreased 78 basis points since its record high point in February of 7.1%. The increase since May suggests managed Medicare admissions have increased since the lows of the pandemic, but they are likely significantly below levels prior to the pandemic. As cases of COVID-19 continue to grow and some states implement restrictions once again, it is possible that managed care patient days are further pressured if elective surgeries are suspended again. In addition, managed Medicare revenue mix increased 61 basis points from August to September to 8.8%. However, it is has declined 110 basis points since March and 188 basis points since February, when it was 10.7% before the pandemic started. At its peak in March 2019, it was 11.8%.
   
4. Medicare revenue mix increased slightly from August to September, ending at 21.8%. Medicare revenue mix has held up relatively well since the pandemic began in March, compared with other payors. It is up 46 basis points since March compared to managed Medicare (down 110 basis points) and private (down 134 basis points). In addition, skilled mix has increased 47 basis points since March driven by the increase in Medicare patient day mix. Medicare patient day mix decreased slightly from August to end September at 12.4%. However, it has increased 97 basis points since March.  As overall occupancy has declined dramatically during the pandemic creating significant pressure on skilled nursing operators, Medicare patient days likely did not decrease as much as it would have given that the Centers for Medicare and Medicaid Services (CMS) waived the 3-Day Rule, which waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered skilled nursing stay.  

To get more trends from the latest data you can download the Skilled Nursing Monthly Report here. There is no charge for this report.  

The report provides aggregate data at the national level from a sampling of skilled nursing operators with multiple properties in the United States. NIC continues to grow its database of participating operators in order to provide data at localized levels in the future. Operators who are interested in participating can complete a participation form here. NIC maintains strict confidentiality of all data it receives. 

The NIC MAP^® Data Service recently released national monthly data through September 2020 for actual rates and leasing velocity. In this release, NIC also provided data on three metropolitan areas for which there is enough data to report:  Atlanta, Philadelphia, and Phoenix.  

U.S. National Trends—Memory Care Segment—3Q20 

A few of the key takeaways from the 3Q2020 Seniors Housing Actual Rates Report are listed below. Full access to the reports and other takeaways is available to NIC MAP® Data Service clients.  

• • Average initial rates for residents moving into independent living, assisted living and memory care segments were below average asking rates, with monthly spreads generally largest for memory care. Care segments refer to the levels of care and services provided to a resident living in an assisted living, memory care or independent living unit.   
  • The average discount for the memory care segment was the largest of the three care segments in September 2020 and averaged 8.4% below average asking rates. This equates to an average initial rate discount of 1.0 month on an annualized basis, more than in June, July, or August, but less than in September 2019 (1.2 months).  
  • For the assisted living segment, average in-place rates were consistently below average asking rates since reporting began in January 2017. However, the monthly gap between these two rates is shrinking and was only 0.4% or $18 in September 2020. One year ago, it was 3.4% or $170.   

• • The rate of move-outs has exceeded or equaled the rate of move-ins for each of the prior twelve months for both the independent living and assisted living segments, and for seven of the last twelve months for the memory care segment as of September 2020. The difference between the pace of move-outs and move-ins was widest in the immediate aftermath of the pandemic in the March, April, and May period. 
  • There was monthly variation in initial rate discounts by geography and care segment during the third quarter of 2020. Of the three metropolitan markets currently being reported by the NIC MAP® Data Service (Atlanta, Philadelphia, and Phoenix), Philadelphia’s independent living  segment had the largest discount in initial rates relative to asking rates, with a discount equivalent to 2.4 months at an annualized basis in September 2020.  
  • Atlanta’s assisted living segment had a large initial rates discount relative to asking rates at 1.9 months (annualized) in September 2020. In contrast, Phoenix had no discount and Philadelphia offered 0.5-month discount. This compares with 0.7 month for the assisted living segment at the national level.   

The NIC Actual Rates Initiative is driven by the need to continually increase transparency in the seniors housing sector and achieve greater parity to data that is available in other real estate asset types. Now, more than ever, in the world of the COVID-19 pandemic, having access to accurate data on the actual monthly rates that a seniors housing resident pays as compared to property level asking rates helps NIC achieve this goal. 

The Seniors Housing Actual Rates Report available in NIC MAP provides aggregate national data from approximately 300,000 units within more than 2,500 properties across the U.S. operated by 25 to 30 seniors housing providers. The operators included in the current sample tend to be larger, professionally managed, and investment-grade operators as we currently require participating operators to manage 5 or more properties. Note that this monthly time series is comprised of end-of-month data for each respective month. 

Note that the data reported here is on care segment, where care segment type refers to each part or section of a property that provides a specific level of service, i.e., independent living, assisted living or memory care. NIC also has this data for majority property type, where majority property type refers to which care segment comprises the largest share of inventory. In addition, care segment actual rates data is also available for the Atlanta, Phoenix and Philadelphia CBSAs. 

While these trends are certainly interesting aggregated across the states, actual rate data is even more useful at the CBSA level. As NIC continues to work toward growing the sample size to be large enough to release more data at the CBSA level, partnering with leading software providers like Yardi, PointClickCare, Alis, and MatrixCare makes it easier for operators to contribute data to the Actual Rates Initiative. NIC appreciates our partnerships with software providers and our data contributors and their work in achieving standardized data reporting. 

If you are an operator or a software provider interested in how you can contribute to the Actual Rates Initiative, please visit nic.org/actual-rates. 

For seniors housing and care operators, the battle to protect residents from the deadly COVID-19 global pandemic can get personal. Their experiences, particularly in the early days of the disease’s spread, shed light on the immense effort it has taken to protect America’s most vulnerable elders, and also on the toll that struggle has taken on residents – and staff – alike.  

The 2020 NIC Fall Conference presented a collection of “Operator Spotlights” designed to provide some first-person insight straight from the leaders who have been facing the pandemic, and its many challenges, every day since it first hit the U.S. Each spotlight focused on not only the challenges faced, but the solutions leaders put in place—short term and long term—to protect their staff and residents from potentially spreading or contracting the disease. 

Fee Stubblefield, CEO, The Springs Living, focused on the science of detecting COVID-19 with surface testing. Saying, “In the early days of COVID we weren’t sure what information to believe,” Stubblefield explained how surface testing led his company to understand that COVID-19 is actually airborne, and continues to be a powerful tool to help prevent infection throughout the company’s communities.  

Stubblefield pointed out that surface testing offers many advantages to operators. Response rates are quick, and it can detect the presence of COVID-19 even when residents test negative. Regular testing inspires confidence in residents and staff, at a lower cost than managing an outbreak. Looking ahead, Stubblefield said that, “COVID-19 has changed the way seniors housing providers must operate. Organizations will need to embrace the reality that you cannot deliver great care without delivering a safe environment.” 

Lynne Katzmann, President & CEO, Juniper Communities, focused on collaboration, as well as prevention and rapid, accurate, and inexpensive testing. Katzmann began by saying, “COVID-19 has challenged us all in ways that were unimaginable just six months ago.” Her top three learnings over that period are that COVID-19 is ‘invisible and insidious,” prevention is even more important than control of the disease, and testing is “our key weapon…before there’s a vaccine.”  

Katzmann relayed how she looked early on at the testing and contact tracing which had seen success overseas, and decided to employ similar tactics, even at a time when many believed testing should be conducted only on symptomatic individuals. Like Stubblefield, who worked with academic institutions to help study the virus’ spread, Katzmann partnered with the scientific community on innovation, both to help, as she said, “not only to protect Juniper, but to also positively impact our industry, and most importantly the wellbeing of older adults.”  

Working with CRISPR gene-splicing scientists from MIT, and a testing lab, Juniper helped validate a new cheek swab test, which they’ve been using since September. She believes the test, which is more comfortable, and doesn’t require a healthcare professional to administer, will enable broader and more affordable testing across the industry. 

Lori Alford, COO, Avanti Senior Living took a few minutes to focus on the importance of managing stress for her exhausted staff. Saying, “COVID fatigue is extraordinarily real,” Alford described just how difficult the COVID-19 pandemic has been, both for frontline workers and the support and leadership staff who face the threat and challenges of the pandemic on a daily basis. “They not only had to manage the fear, they had to manage their children being home all day, or dealing maybe with their spouse being home, but they continued to have to go to work,” she explained.  

Avanti launched a 6-week coaching program with staff because “What the team needed was mental wellness.” Each week, staff participated by watching a video, joining a group coaching call, and journaling throughout the week. Despite early skepticism, Alford saw real improvements in her team. “At the end of the six week journey…not only did I see a difference in transformation in the minds when they came to work for Avanti, but I would listen to them talk, and they would say, ‘I’ve shared this with my family. I’ve shared this with my friends. This has helped me grow personally, not just professionally…’ as a leader, ‘Wow!’…I would put this in the top 3 career highlights.”  

As a result of the positive results on their initial coaching program, Avanti is rolling it out for every department head in the organization, with hopes of eventually making the program available for the rest of their staff as well. 

For Dwayne J. Clark, Founder & CEO, Aegis Living, it was essential to be creative and proactive early on in the crisis. He described numerous initiatives his organization launched, in order to understand how to fight COVID-19, best serve the needs of residents and families, and how to support his staff through an extremely difficult and stressful period.  

Early on, Aegis Living formed an advisory council. “We relied heavily on these seven professionals,” he said, describing their diverse medical backgrounds, spanning gerontology, epidemiology, immunology, naturopathy, and even psychiatry. Aegis then launched numerous initiatives. These included chat suites for residents, outdoor living rooms, where residents could meet and even dine with family members and loved ones, and ‘hugging walls,’ which enable a safe means to touch, hold hands, and hold one another through a medically safe disposable barrier.  

Like Alford, Clark discussed the need to provide emotional support for staff. They implemented a telemedicine program, available to staff and their families for immediate access to a doctor – without having to undertake the risk of a hospital visit. $1 meals were available for staff to take home to their families. A childcare swapping program better enabled staff to manage their at-home childcare needs. “So, we really had to be creative, we really had to listen to our employees, and think about ‘what are their issues.” Said Clark. He pointed out that, at a time when many providers are struggling to get staff to come to work, Aegis has avoided that problem. “It was because we were so thoughtful about their food needs, their medical needs, their childcare needs, their mental health needs.” 

Jack Callison, CEO, Enlivant, not only faced the threat of COVID-19, but had to evacuate several properties as the result of both Hurricane Laura, which caused flooding in Lake Charles, Louisiana, and wildfires that forced evacuation from Talent, Oregon. His presentation focused on lessons learned from those experiences. “You’ve probably got your evacuation protocols, and I’m sure everybody has their COVID protocols; but you need to merge those two playbooks together,” Callison said.  

He then reviewed numerous details to consider, including doubling the number of busses that will be needed during a pandemic, in order to maintain social distancing. He suggested reaching out to local EMS and fire departments for help loading and offloading frail elders. In some cases, Enlivant found that evacuating to a hotel was the better choice, over moving residents to a sister facility. In every case, he advised to ensure to drop-ship appropriate supplies of PPE to the evacuation site.  

Callison provided tips for coordinating with a hotel. Call ahead and have the hotel remove door bars, to avoid the possibility of staff being barred from entry. Also, ask for universal key cards to access rooms. He also emphasized the need to maintain social distancing, in some cases separating numerous evacuated communities by keeping them on separate floors, and always keeping residents in their rooms. Enlivant also “opened the door” for family members and even pets, to join their residents for the evacuation. The organization arranged to take over the hotels’ commercial kitchens, in order to ensure safety protocols, and prepare three meals a day for every evacuee. They also coordinated with their food service provider to route food deliveries to the hotel. 

“The most important thing that we did, that served us well,” Callison said, was a daily call hosted by executive directors with families. The 4PM daily calls delivered consistent messaging to families and provided the efficiency of answering questions all at once, rather than in a time-consuming one-by-one approach. Callison, like all of the other operator leaders, also mentioned another core aspect of success: his staff. He said, “everything that I’ll share with you today is a function of the amazing human beings we have in the Enlivant communities, who are executing our protocols every single day. We’re so incredibly proud of the wonderful job they’re doing, keeping our elderly population safe.” 

Video replays of these Operator Spotlights remain available to registrants of the NIC 2020 Fall Conference. Click here to log in to on demand access.   

The Labor Department reported that nonfarm payrolls rose by 245,000 in November and that the unemployment rate fell to 6.7% from 6.9% in October.  This suggests that the employment recovery from the COVID-related drop in March and April continues, but at a decelerating pace.  The consensus estimates for November had been for a gain of 470,000.  In November, nonfarm employment was below its February level by 9.8 million jobs or by 6.5%.

Health care added 46,000 jobs in November, with the largest gains occurring offices of physicians and home health care services.  Health care employed 527,000 fewer workers in November than in February.  Nursing care facilities lost 12,000 jobs in November.

The 0.2 percentage point drop in the November unemployment rate to 6.7% marked the seventh consecutive month of improvement.  It is 3.2 percentage points above the pre-pandemic level of 3.5% seen in February, however, but well below the 14.7% peak seen in April.

The number of long-term unemployed (those jobless for 27 weeks or more) increased by 385,000 to 3.9 million, a figure that suggests that is continues to be a very challenging time for many Americans.  Long-term unemployed persons account for 36.9% of the total number of unemployed persons.  The number of permanent job losers rose 59,000 to 3.7 million and is 2.5 million more than in February.

The underemployment rate or the U-6 jobless rate fell to 12.0% in November from 12.1% in October.  This figure includes those who have quit looking for a job because they are discouraged about their prospects and people working part-time but desiring a full work week.

A separate report issued yesterday on unemployment insurance claims showed that more than 20.2 million workers remain on government assistance in the week ended November 14.

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.09 in November to $29.58, a gain of 4.4% from a year earlier.  The large employment fluctuations over the past several months, especially in industries with lower-paid workers—complicate the analysis of recent trends in average hourly earnings.

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work slipped to 61.5% in November, down from 61.7% in October.  The employment-population ratio was little changed at 57.3% in November and is 3.8 percentage points lower than in February.

The change in total nonfarm payroll employment for September was revised up by 39,000 from 672,000 to 711,000 and the change for October was revised down by 28,000 from 638,000 to 610,000.   Combined, 11,000 jobs were added to the original estimates.   Monthly revisions result from additional reports received from businesses and government agencies since the last published estimates and from the recalculation of seasonal factors.

The slowdown in monthly gains in employment is troubling.  Further weakness in employment growth is likely due to the ongoing large number of newly diagnosed COVID-19 infections and its impact on business closures and job security.  Many states are re-imposing lockdowns.  Congress needs to act to implement further fiscal stimulus to keep the recovery on track.  Without a fiscal stimulus package, the recession is likely to deepen until a vaccine can be safely and widely distributed.